Suffering physical trauma in an accident is difficult enough, but when your health insurance refuses to cover the medical costs, it can feel like adding insult to injury.
Unfortunately, many health insurance plans do not always cover accident-related treatment, at least not without a fight. Knowing your options for managing post-care expenses can help you avoid significant out-of-pocket costs.
Why your health insurance might not cover accident injuries
When physical damage is caused by an accident, whether a car crash, a fall or a third party’s negligence, health insurers may try to shift responsibility. They often argue that another insurance policy should be responsible. The complex process of identifying which coverage should shoulder the costs can delay or even block your access to benefits.
Your insurance may reject your claim for several other reasons. If there is missing or incomplete accident documentation, such as police reports or medical records, it can lead to a denial. Reporting the injury late or delaying treatment can also raise doubts about the validity of your claim. If you sought care from out-of-network providers, your insurance may not cover the treatment. Lastly, if the insurer considers the treatment unnecessary or finds that it exceeds your policy’s coverage limits, they may deny your request.
What to do after your injury care
Finding out that you might have to cover your medical costs all by yourself can feel overwhelming. Learning why the insurer rejected your claim and knowing how to respond can help you take control of the situation. Here are some actions you can take:
- Read the denial letter closely: Understand what options you have to appeal.
- Gather documentation: Keep all medical records, bills, accident reports and communication with providers.
- File an internal appeal: Follow your insurer’s formal process and meet all deadlines to challenge the denial.
- Speak to an attorney: Get help pursuing compensation and negotiating with insurers on your behalf.
While the appeals process can be tedious and time-consuming, taking these steps may improve your chances of receiving proper compensation.
The first step forward
It’s easy to feel discouraged, especially when you’re already dealing with pain, stress and financial uncertainty. But keeping thorough records, acting quickly on appeal deadlines, and seeking legal guidance can help you take the next steps towards healing and recovery.